Download Learner Objectives: Upon completion of the unit the resident

CORE COMPETENCY GOALS AND OBJECTIVES OF THE CONGENITAL
CARDIOTHORACIC SURGERY ROTATION AT CHRIST HOSPITAL
PGY6
Provided below are the specific educational objectives, and clinical skill acquisition goals for residents
within the Loyola University Medical Center Residency Program in Thoracic Surgery. The program is
under the auspices of the Residency Review Committee for Thoracic Surgery of the Accreditation Council
for Graduate Medical Education (ACGME), and supported by faculty and staff within the Department of
Cardiovascular and Thoracic Surgery.
Learner Objectives will be taught / learned through various means including:
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The TSDA (Thoracic Surgery Directors Association)
Comprehensive Requisite Thoracic Surgery Curriculum
Didactic and other conferences
Perioperative and operative management
Self-education and reading
Faculty demonstration of ACGME core competencies coupled with resident counseling on a daily,
or as needed, basis
EVALUATION
Evaluation of the Thoracic Surgery Resident’s understanding of the topic will be reviewed (in part) at the
time of operation, or resident-faculty interaction, which exemplifies these topics. Feedback will be verbal
and immediate. Faculty will evaluate the Thoracic Surgery Residents based upon stated objectives as
part of the ACGME core competencies. These portions of the curriculum will be viewed as “Medical
Knowledge” and “Patient Care [e.g. operative skills, and perioperative management, etc.].
Faculty will evaluate residents at the end of the rotation, in writing, based upon these objectives and the
ACGME core competencies. Additional evaluations will be conducted for operative skill performance
(faculty evaluating residents), and operative skill education (residents evaluating faculty). The remaining
core competencies will be taught and evaluated as per the Goals and Objectives for Thoracic Surgery
Residents. Residents will evaluate faculty teaching and education efforts as well as the rotation. Both will
occur at the conclusion of the rotation. The program will be evaluated annually. Questions or comments
can be directed to the Residency Coordinator or to the Program Director.
EVALUATION INSTRUMENTS
The evaluation instruments are completed in the GME System. The evaluation instruments include:
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Faculty evaluation of Resident
Resident evaluation of Faculty
Resident evaluation of rotation
Resident evaluation of program
Daily feedback from faculty to resident
Didactic lectures
Patient care settings
o Operating room
o Intensive care unit
o General care wards
o Outpatient clinics
o Other
Non-patient care settings
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OTHER COMMENTS / RESPONSIBILITIES
The Congenital Cardiothoracic Surgery practice headquartered at Christ Hospital is a multi-surgeon,
multi-hospital practice. As such, the rotation has been designed around operative experience, postoperative care, and multi-disciplinary conference-based patient evaluation. There is no single scheduled
clinic day. As such, it is up to the individual resident to demonstrate initiative to follow specific patients
pre- and postoperatively as outpatients to gain a longitudinal perspective on their care. Daily rounds and
patient care responsibilities will include a sign-out to ICU staff highlighting intra-operative details and their
impact on the post-operative care plan. Residents are expected to stay at the fresh post-operative
bedside until reasonable stability is achieved.
As this rotation is off-site, attendance at regular Loyola Departmental conferences is not expected.The
resident is required to keep up with the weekly TSDA curriculum conference, and complete the
associated on-line quizzes. Our residents are required to participate in
 Weekly Pediatric Cardiology/Pediatric Cardiothoracic Surgery Conference
 Weekly Pediatric Cardiology Fellow’s Conference
 Such didactic activities as each service attending may individually schedule
GOALS AND OBJECTIVES ORGANIZED BY CORE COMPETENCY
The following are specific goals and objectives of the training rotation, organized by clinical core
competency, as outlined by the ACGME. When relevant, goals and objectives related to the activities
listed above are provided to illustrate the attention paid to the competency during this rotation. The list is
not meant to be exhaustive.
IV.A.5.b)
Medical Knowledge
Residents must demonstrate knowledge of established and evolving biomedical, clinical,
epidemiological and social-behavioral sciences, as well as the application of this
knowledge to patient care. Residents:
IV.A.5.b).(1) will know current medical information, and critically evaluate
scientific information;
Medical Knowledge (Learner Objectives) and Clinical Skills (Patient Care) follow. This list is meant to be a
starting point for the Thoracic Surgery Resident and is not meant to preclude additional reading or
independent study nor limitation of time within the operating room, general care wards, or the outpatient
clinic.
CONGENITAL HEART DISEASE
Anatomy and History
Learner Objectives: Upon completion of the unit the resident will be able to:
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Describe the embryology and anatomy of the normal heart;
Discuss the history of congenital cardiac surgery, and the intellectual development of operations
used to manage each cardiac anomaly.
 Discuss the embryology and anatomy of major cardiac anomalies;
 Interprets angiocardiograms, echocardiograms, and other images and correlates these with
normal and abnormal cardiac anatomy.
Clinical Skills: During the training program the resident:
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Applies knowledge of the normal and abnormal anatomy of the heart to the planning and
performance of operations;
Interprets angiocardiograms, echocardiograms, and other images to diagnose congenital heart
disease;
Uses knowledge to select the best procedure for individual patients.
Physiology and Physiologic Evaluation
Learner Objectives: Upon completion of the unit the resident:
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Describes normal fetal circulation;
Describes the transitional nature of circulation as the fetus becomes a neonate;
Discusses the physiology of obstructions, of intra- and extracardiac shunts, of abnormal
connections to the heart, and of combinations of these anomalies in the fetus, neonate, and child.
Clinical Skills: During the training program the resident:
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Describes the physiologic changes of circulation during neonatal life;
Diagnoses clinically important congenital heart diseases in the neonate, infant, and child;
Applies a knowledge of anatomic abnormalities and their physiologic consequences to diagnose
congenital heart defects;
Applies calculations of blood flows and resistances from cardiac catheterization data.
Manages the physiologic aspects of the neonate, infant, and child with congenital heart disease
preoperatively, intraoperatively, and postoperatively;
Stabilizes patients who are critically ill with congenital heart disease.
Cardiopulmonary Bypass for Operations on Congenital Cardiac Anomalies
Learner Objectives: Upon completion of the unit the resident:
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Identifies arterial and venous cannulation techniques for different intracardiac defects;
Summarizes the indications for the various techniques of bypass (anatomy, pathophysiology, and
technical requirements of the underlying cardiac defects);
 Comprehends the techniques of myocardial protection in the neonate and young infant;
 Describes the use of varying levels of hemodilution and anticoagulation;
 Discusses perfusion flow and pressure control;
 Identifies the methods of body temperature manipulation, and the indications for and techniques
of profound hypothermia with and without total circulatory arrest
Clinical Skills: During the training program the resident:
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Carries out arterial and venous cannulation and initiates cardiopulmonary bypass;
Contributes in the repair of congenital heart defects using cardiopulmonary bypass.
Executes arterial and venous cannulation and initiates cardiopulmonary bypass;
Oversees the perfusionist in the intraoperative management and conduct of cardiopulmonary
bypass;
Left-To-Right Shunts
Learner Objectives: Upon completion of the unit the resident is able to:
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Identify the anatomy, embryology, and physiology of the most common or important anomalies;
Discuss the operative indications of the most common or important anomalies;
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Describe the technical components of the operative repair of the most common or important
anomalies;
 Comprehends the postoperative care of each anomaly.
Clinical Skills: During the training program the resident:
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Demonstrates the preoperative evaluation of patients with each of these anomalies;
Participates in the operative repair of ventricular septal defects;
Repairs more complex cardiac anomalies;
Executes the preoperative evaluation of patients with each of these anomalies.
Manages postoperative care
Cyanotic Anomalies
Learner Objectives: Upon completion of the unit the resident:
 Describes the anatomy and physiology of each anomaly;
 Recites the methods of diagnosis;
 Assumes the role of medical management and interventional cardiology as treatment options;
 Discerns the indications for and timing of operation;
 Comprehends the technical components of operative repair;
 Recognizes the postoperative care, expected outcome, long-term results, and complications.
Clinical Skills: During the training program the resident:
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Does major palliative operations for these congenital cardiac anomalies;
Does preoperative evaluation and preparation;
Manages postoperative care.
Does operative repair of tetralogy, TGA, Truncus arteriosus, TAPVR, Ebstein's anomaly, and
Fontan-type operations.
Obstructive Anomalies
Unit Goal: At the end of this unit the resident comprehends the anatomy and physiology of obstructive
anomalies of the left and right sides of the heart and aorta, their diagnosis, management, and
postoperative care, and takes part in the operative and non-operative treatment.
Learner Objectives: Upon completion of the unit the resident:
 Defines the anatomy and physiology of each anomaly;
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Recites the methods of diagnosis;
 Describes the role of medical management and interventional cardiology;
 Discusses the principles of postoperative care;
 Summarizes the technical components of operative repair;
 Explains the expected outcome, long-term results and complications.
Clinical Skills: During the training program the resident:
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Demonstrates corrections for patent ductus arteriosus and coarctation of the aorta;
Demonstrates preoperative evaluation and preparation;
Manages postoperative care;
Uses prostaglandins in the management of patients with neonatal coarctation, interrupted aortic
arch, critical aortic stenosis.
Congenital Cardiac Surgery Rotation at Christ Hospital Goals & Objectives (reviewed 10/13)
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Demonstrates surgical ability with aortic valvotomy, repair of supravalvular and subvalvular aortic
stenosis, pulmonary valvotomy, correction of subvalvular pulmonary stenosis, correction of
vascular rings.
 Does operations for left ventricular outflow obstruction and interrupted aortic arch.
CONGENITAL CHEST WALL
Congenital Abnormalities and Thoracic Outlet Syndrome
Learner Objectives: Upon completion of this unit the resident:
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Recognizes
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Recognizes the varied presentations of thoracic outlet syndrome and interprets diagnostic tests;
Reads and interprets diagnostic x-ray and applies physiologic examinations for congenital chest
wall defects and thoracic outlet syndromes;
Evaluates and treats patients with congenital chest wall malformations;
Takes part in the operative reconstruction of selected chest wall defects;
Executes first rib and cervical rib resection and repairs or releases vascular and neural
abnormalities associated with thoracic outlet syndrome;
pectus excavatum and pectus carinatum, describes possible physiologic
disturbances, and interprets diagnostic tests to identify such physiologic disturbances;
 Recognizes the indications for the operative treatment of congenital chest wall abnormalities;
 Defines the complications of reconstruction of congenital chest wall abnormalities and their
management;
 Describes the etiology, evaluation, differential diagnosis, and diagnostic criteria for thoracic outlet
syndrome;
 Discusses the operative and non-operative management of thoracic outlet syndrome.
Clinical Skills: During the training program the resident:
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CONGENITAL LUNGS AND PLEURA
Congenital Lung Disease
Learner Objectives: Upon completion of this unit the resident:
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Recognizes various congenital lung abnormalities and describes their anatomy and indications for
treatment
Clinical Skills: During the training program the resident:
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Evaluates patients with congenital lung abnormalities;
Executes operations for congenital lung abnormalities and their complications.
CONGENITAL ESOPHAGUS
Congenital Abnormalities
Learner Objectives: Upon completion of this unit the resident:
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Recognizes the clinical presentations, types, diagnosis and treatment of esophageal atresia and
congenital tracheo-esophageal fistula;
 Appreciates the clinical presentation and diagnosis of esophageal duplication cysts.
Clinical Skills: During the training program the resident:
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Evaluates patients with various types of esophageal atresia/tracheoesophageal fistula and
recommends management;
Completes diagnostic tests of congenital esophageal diseases;
Assists in the operative repair of tracheo-esophageal fistula;
Contributes to the operative management of esophageal duplication cysts.
CONGENITAL MEDIASTINUM
Congenital Abnormalities of the Mediastinum
Learner Objectives: Upon completion of this unit the resident:
 Is able to diagnose mediastinal cysts;
 Recognizes the symptoms associated with mediastinal abnormalities.
Clinical Skills: During the training program, the resident:
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Reads
and interprets plain radiographs, CT scans, MRI's and contrast studies of congenital
abnormalities of the mediastinum;
Diagnoses and manages patients with congenital abnormalities of the mediastinum.
CONGENITAL DIAPHRAGM
Congenital Abnormalities
Learner Objectives: Upon completion of this unit the resident:
 Describes the anatomy of congenital diaphragmatic hernias;
 Discusses the physiologic consequences of diaphragmatic hernias;
 Recognizes the indications for operative repair of diaphragmatic hernias;
 Diagnoses and manages infants and adults with diaphragmatic hernias.
Clinical Skills: During the training program the resident:
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Evaluates
neonates with congenital diaphragmatic hernias;
in the operative treatment of infants with diaphragmatic hernias;
Contributes in the preoperative and postoperative management of multisystem abnormalities of
infants with congenital diaphragmatic hernias;
Completes operative treatment of adults with delayed presentation of diaphragmatic hernias;
Manages eventration of the diaphragm in children and adults.
Assists
Miscellaneous Anomalies
Learner Objectives: Upon completion of the unit the resident:
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Describes the natural history, evaluation, and treatment of coronary anomalies, congenital
complete heart block, hypoplastic left heart syndrome, pulmonary atresia (with and without VSD),
“corrected transposition”, single ventricle, cortriatriatum, and cardiac tumors.
 Discusses the role of corrective and palliative operations for the above anomalies and of cardiac
transplantation for appropriate cardiac pathology.
Clinical Skills: During the training program the resident:
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Does pacemaker insertion, systemic-to-pulmonary artery shunting for pulmonary atresia or
stenosis (with or without VSD), and pulmonary artery banding for large left-to-right shunts;
Evaluates angiocardiograms, echocardiograms, and cardiac catheterizations of the above
anomalies;
Develops treatment plans for the above anomalies;
Assists in operative treatment for the above anomalies;
Manages postoperative care for the above anomalies.
Develops treatment plans for the above anomalies;
Assists in operative treatment for the above anomalies.
Principles of Postoperative Care
Learner Objectives: Upon completion of the unit the resident:
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Identifies the physiologic characteristics of neonates and small infants;
Describes the management of infants and children who have undergone operative correction of
simple and complex congenital cardiac anomalies;
 Comprehends the postoperative management of patients with systemic-to-pulmonary artery
shunts;
 Defines the management of patients who have had a right heart bypass operation;
 Discusses the physiologic preoperative and postoperative management of patients with
hypoplastic left heart syndrome;
 Describes which infants and children are prone to have a pulmonary hypertensive crisis;
 Defines the prevention, recognition, and treatment of pulmonary hypertensive crises.
Clinical Skills: During the training program the resident:
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Manages ventilators for infants and children with and without obligatory intracardiac shunts;
Assesses the cardiac output and pulmonary and systemic resistance in infants and children;
Uses physiologic and pharmacologic manipulation of preload, myocardial contractility, heart rate,
and afterload to optimize cardiac output in critically ill infants and children;
Evaluates the metabolic reserve of neonates and infants and provides prompt therapeutic
intervention as indicated;
Identifies problems and complications of postoperative pediatric patients and provides
appropriate treatment.
IV.A.5.c) Practice-based Learning and Improvement
Residents must demonstrate the ability to investigate and evaluate their care of patients,
to appraise and assimilate scientific evidence, and to continuously improve patient care
based on constant self-evaluation and life-long learning. Residents are expected to
develop skills and habits to be able to meet the following goals:
IV.A.5.c).(1) identify strengths, deficiencies, and limits in one’s knowledge and
expertise;
The resident is expected to:
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Work with faculty and the program director to identify deficiencies and knowledge using the
inservice training exam, and TSDA curriculum quizzes, clinical conferences, and daily clinical
practice
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IV.A.5.c).(2) set learning and improvement goals;
The resident is expected to:
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Work with faculty to improve comprehension or performance as measured by inservice, and
TSDA weekly exams, and to seek regular feedback on technical and clinical skills
IV.A.5.c).(3) identify and perform appropriate learning activities;
The resident is expected to:
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Complete weekly TSDA reading/viewing assignments, and read such extra sources as may be
assigned for clinical conferences or to address deficiencies.
IV.A.5.c).(4) systematically analyze practice using quality improvement methods,
and implement changes with the goal of practice improvement;
IV.A.5.c).(5) incorporate formative evaluation feedback into daily practice;
The resident is expected to:
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Periodically review results of 360 degree evaluations with the Program Director
IV.A.5.c).(6) locate, appraise, and assimilate evidence from scientific studies
related to their patients’ health problems;
The resident is expected to:
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Discuss alternative treatment strategies with an attending prior to a procedure,
supporting decision making with relevant literature
Read published material and listen to presentations critically;
Demonstrate competence by:
o Defining an analyzable problem or scientific question
o Assembling an appropriate literature review
o Synthesizing and analyzing available data
o Formulating an informed and insightful discussion
o Composing a properly constructed, critically reviewed bibliography or list of
literature citations
Show an understanding of the appropriate application of statistical tests to the problem;
Demonstrate an understanding of the appropriate application of other commonly used
statistical tests such as univariate analysis, multivariate analysis, analysis of variance,
and the use of T-tests for paired data and multiple comparisons. (Residents should know
the limitations, deficiencies and proper applications of these commonly used statistical
tests);
o •Show evidence of ability to critically analyze major clinical research papers in
the thoracic literature which guide practice;
•Apply knowledge of the scientific method to design and execute at least one formal
analysis to solve a problem related to thoracic surgery.
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IV.A.5.c).(7) use information technology to optimize learning;
IV.A.5.c).(8) participate in the education of patients, families, students, residents
and other health professionals.
IV.A.5.c).(9) demonstrate the ability to practice lifelong learning, analyze personal
practice outcomes, and use information technology to optimize patient care.
IV.A.5.d) Interpersonal and Communication Skills
Residents must demonstrate interpersonal and communication skills that result in the
effective exchange of information and collaboration with patients, their families, and
health professionals.
IV.A.5.d).(1) communicate effectively with patients, families, and the public, as
appropriate, across a broad range of socioeconomic and cultural backgrounds;
IV.A.5.d).(2) communicate effectively with physicians, other health professionals,
and health related agencies;
IV.A.5.d).(3) work effectively as a member or leader of a health care team or other
professional group;
The resident is expected to:
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Lead the conduct of a case, co-ordinating with nursing, anesthesia, and perfusion staff
under direct faculty observation
Lead the conduct of resuscitation and other emergency care under direct faculty
supervision
IV.A.5.d).(4) act in a consultative role to other physicians and health
professionals; and,
The resident is expected to:
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Conduct history and physicals, review laboratory and imaging studies promptly, and
synthesize this data into a differential diagnosis, and treatment plan with a faculty
member in a prompt and effective fashion.
Determine specific questions and objectives for which the consult has been requested.
IV.A.5.d).(5) maintain comprehensive, timely, and legible medical records, if
applicable.
The resident is expected to:
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Gain facility in the use of the Cerner EMR systems
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Forward all documentation for review and co-signature of the attending using the Cerner
EMR system.
IV.A.5.e) Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities
and an adherence to ethical principles. Residents are expected to demonstrate:
IV.A.5.e).(1) compassion, integrity, and respect for others;
IV.A.5.e).(2) responsiveness to patient needs that supersedes self-interest;
IV.A.5.e).(3) respect for patient privacy and autonomy;
IV.A.5.e).(4) accountability to patients, society and the profession; and,
IV.A.5.e).(5) sensitivity and responsiveness to a diverse patient population,
including but not limited to diversity in gender, age, culture, race, religion, disabilities,
and sexual orientation.
IV.A.5.e).(6) high standards of ethical behavior; demonstrate continuity of care
(pre-operative, operative, and post-operative); demonstrate sensitivity to age, gender,
culture, and other differences; and demonstrate honesty, dependability, and
commitment.
IV.A.5.f) Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to the larger context
and system of health care, as well as the ability to call effectively on other resources in
the system to provide optimal health care. Residents are expected to:
IV.A.5.f).(1) work effectively in various health care delivery settings and systems
relevant to their clinical specialty;
IV.A.5.f).(2) coordinate patient care within the health care system relevant to their
clinical specialty;
IV.A.5.f).(3) incorporate considerations of cost awareness and risk-benefit
analysis in patient and/or population-based care as appropriate;
IV.A.5.f).(4) advocate for quality patient care and optimal patient care systems;
IV.A.5.f).(5) work in interprofessional teams to enhance patient safety and improve
patient care quality; and,
IV.A.5.f).(6) participate in identifying system errors and implementing potential
systems solutions.
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IV.A.5.f).(7) practice cost-effective care without compromising quality, promote
disease prevention, demonstrate risk-benefit analysis, and know how different practice
systems operate to deliver care.
The Resident is expected to:
•Understand organizational structure and mechanics of solopractice, group specialty practice, multispecialty practice, and academic practice;
•Know the structure, responsibilities and requirements of managed care, capitation payment, contractual
agreements, physician-hospital organizations, and independent Practice agreements.
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